Norfolk and Suffolk NHS Foundation Trust
Pharmacy, Hellesdon Hospital, Norwich, NR6 5BE
http://www.nsft.nhs.uk/

Professor Stephen Bazire
01603-421452
steve.bazire@nsft.nhs.uk

How many medicines should I be taking for my symptoms of depression?

There are no easy answers to this and it is a very individual choice. Below are some of the combinations that are used with the reasons. This is not a complete list but you might want to talk to your prescriber about any not on this list.

Generally just the one antidepressant is best, as many combinations can have interactions and be dangerous (including when switching from one to another). Combining drugs of a similar way of working is usually pointless and may give more side effects. Sometime combining medicines can help reduce side effects.

Main medicine Second medicine Reason

A serotonin booster (e.g. citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, duloxetine or trazodone)

Mirtazapine

May help side effects such as sexual ones (e.g. not being able to have an orgasm), anxiety and agitation

A serotonin booster (e.g. citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, duloxetine or trazodone)

Reboxetine

If the SSRI has only been partly effective

A serotonin booster (e.g. citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, duloxetine or trazodone)

Tryptophan

Depression that’s hard to treat

A serotonin booster (e.g. citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, duloxetine or trazodone)

Lithium (and possibly tryptophan too)

Depression that’s really hard to treat

A serotonin booster (e.g. citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, duloxetine or trazodone)

Benzodiazepines (e.g. clonazepam, lorazepam, diazepam) for a few weeks

If agitiation happens when you start the antidepressant

A serotonin booster (e.g. citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, duloxetine or trazodone)

Mood stabiliser e.g. valproate, lithium etc or lamotrigine

In the depression is part of bipolar mood disorder

Any antidepressant

Antipsychotics (e.g. risperidone, olanzapine, quetiapine, pericyazine)

If there is agitation or psychotic symptoms

4.10 

Main pharmacy contact points

Main Trust switchboard in Norwich, tel: 01603-421421
Dispensary and all enquiries, tel: 01603-421212, fax: 01603-421365
Pharmacy office tel: 01603-421319
Medicines Information tel: 01603-421212
Unthank Road pharmacy tel: 01603-750031
Deputy Director and Clinical Pharmacy Manager John Hunter, tel: 01603-421364

Opening hours:
Main pharmacy open Monday to Friday: 8.30-16.30 (open at 9.15 on Wednesdays for staff meeting)
Unthank Road pharmacy tel: 01603-671917 open 9.15-12.00 Monday to Friday, also Tuesday and Wednesday afternoons for dose assessments.

Service objectives:
The pharmacy service to Norfolk and Suffolk NHS Foundation Trust has five main aims:

  1. Efficient drug distribution and purchasing
  2. Provision of accurate and independent education and information about medicine therapy to service users and carers
  3. Information and education for Trust and other professionals, and voluntary helpers
  4. Clinical activities to help ensure the optimum use of drug therapies
  5. Medicine management to ensure the most cost-effective use is made of resources